Obstetrics

Question 1

Thrombophilia w/ highest risk of VTE in preg?

Answer 1

Anti-Thrombin def

Question 2

Most common thrombophilia in pregnant women w/ VTE?

Answer 2

Factor V Leidan (Homoz > Heteroz, esp if FHx +)

Question 3

Prophylaxis for pregnant women w/ Fac V Leidan mutation?

Answer 3

If FHx (Hetero) or Homoz - 2-6wks post partum prophylaxis (LMWH)

Question 4

Imaging suspected PE in pregnancy?

Answer 4

VQ - non inferior to CTPA

& CTPA has ↑ breast Ca risk due to hormones

Question 5

Rx VTE in pregnancy?

Answer 5

LMWH
Rx dose: 1mg/kg BD
3-6months (can commence 24hrs post partum)
prophylaxis until 6wk postpartum

Question 6

VTE Prophylaxis regime post partum

(agent, timing, duration)

Answer 6

LMWH at 12hrs post partum prophylactic dose
(6hrs after IDC, regional anaesthesia removed)
2-6wks

Question 7

Which pregnant women get VTE prophylaxis?

• Antenatal
• post partum

Answer 7

Antenatally: if RF eg. prev VTE (oestrogen provoked or thrombophilia) or Antithrombin III def
Postpartum only: non prov VTE, or other thrombophilia

Question 8

1 cause of maternal mortality in Australia

Answer 8

Amniotic Fluid Embolism (AFE)

Question 9

Signs of an amniotic fluid embolism? (x3 main)

& timing?

Answer 9

Usually post partum:
1) HypoTN
2) Haemorrhage
3) Coagulatopathy
(can have SOB, fetal compromise etc)

Question 10

Manage suspected AFE

Answer 10

HELP! Mobilise early

• Blood bank (anticipate DIC products)
• Anaesthetic (perimortem CS, get OT ready)
• ICU